Spatial clustering, social vulnerability and risk of leprosy in an endemic area in Northeast Brazil: an ecological study

Temporal trends and spatial clusters of high risk for maternal death due to COVID-19 pre and during COVID-19 vaccination in Brazil: a national population-based ecological study

OBJECTIVE

This study comprehensively analyzed the temporal and spatial dynamics of COVID-19 cases and deaths within the obstetric population in Brazil, comparing the periods before and during mass COVID-19 vaccination. We explored the trends and geographical patterns of COVID-19 cases and maternal deaths over time. We also examined their correlation with the SARS-CoV-2 variant circulating and the social determinants of health.

STUDY DESIGN

This is a nationwide population-based ecological study.

METHODS

We obtained data on COVID-19 cases, deaths, socioeconomic status, and vulnerability information for Brazil's 5570 municipalities for both the pre-COVID-19 vaccination and COVID-19 vaccination periods. A Bayesian model was used to mitigate indicator fluctuations. The spatial correlation of maternal cases and fatalities with socioeconomic and vulnerability indicators was assessed using bivariate Moran.

RESULTS

From March 2020 to June 2023, a total of 23,823 cases and 1991 maternal fatalities were recorded among pregnant and postpartum women. The temporal trends in maternal incidence and mortality rates fluctuated over the study period, largely influenced by widespread COVID-19 vaccination and the dominant SARS-CoV-2 variant. There was a significant reduction in maternal mortality due to COVID-19 following the introduction of vaccination. The geographical distribution of COVID-19 cases and maternal deaths exhibited marked heterogeneity in both periods, with distinct spatial clusters predominantly observed in the North, Northeast, and Central West regions. Municipalities with the highest Human Development Index reported the highest incidence rates, while those with the highest levels of social vulnerability exhibited elevated mortality and fatality rates.

CONCLUSION

Despite the circulation of highly transmissible variants of concern, maternal mortality due to COVID-19 was significantly reduced following the mass vaccination. There was a heterogeneous distribution of cases and fatalities in both periods (before and during mass vaccination). Smaller municipalities and those grappling with social vulnerability issues experienced the highest rates of maternal mortality and fatalities.

Spatiotemporal pattern of leprosy in southwest China from 2010 to 2020: an ecological study

BACKGROUND

Despite many efforts to control leprosy worldwide, it is still a significant public health problem in low- and middle-income regions. It has been endemic in China for thousands of years, and southwest China has the highest leprosy burden in the country.

METHODS

This observational study was conducted with all newly detected leprosy cases in southwest China from 2010 to 2020. Data were extracted from the Leprosy Management Information System (LEPMIS) database in China. The Joinpoint model was used to determine the time trends in the study area. Spatial autocorrelation statistics was performed to understand spatial distribution of leprosy cases. Spatial scan statistics was applied to identify significant clusters with high rate.

RESULTS

A total of 4801 newly detected leprosy cases were reported in southwest China over 11 years. The temporal trends declined stably. The new case detection rate (NCDR) dropped from 4.38/1,000,000 population in 2010 to 1.25/1,000,000 population in 2020, with an average decrease of 12.24% (95% CI: -14.0 to - 10.5; P < 0.001). Results of global spatial autocorrelation showed that leprosy cases presented clustering distribution in the study area. Most likely clusters were identified during the study period and were frequently located at Yunnan or the border areas between Yunnan and Guizhou Provinces. Secondary clusters were always located in the western counties, the border areas between Yunnan and Sichuan Provinces.

CONCLUSIONS

Geographic regions characterized by clusters with high rates were considered as leprosy high-risk areas. The findings of this study could be used to design leprosy control measures and provide indications to strengthen the surveillance of high-risk areas. These areas should be prioritized in the allocation of resources.

Temporal trend, distribution and spatial autocorrelation of leprosy in Brazil: ecological study, 2011 to 2021

OBJECTIVE

To characterize the temporal trend and spatial behavior of leprosy in Brazil, from 2011 to 2021.

METHODS

This is an ecological study, with data from the Notifiable Diseases Information System, obtained in June 2022. The annual detection rate of new leprosy cases per 100 thousand inhabitants was calculated. To estimate the trend of the 2011-2019 and 2011-2021 series, the polynomial regression model was used, testing first-, second-, and third-order polynomials. For spatiality, natural breaks were used and, later, the univariate global and local Moran's indexes. A significance level of 5% was adopted and the analyses were performed using SPSS®, GeoDa®, and QGIS® software.

RESULTS

The findings indicated an upward trend in the incidence of leprosy in Brazilian regions and in 20 federative units between 2011 and 2019. However, there was a decrease in most of the country when considering the COVID-19 pandemic years. Spatiality showed that the highest detection rates throughout the period were observed in the North, Midwest, and Northeast regions, with high-risk clusters, and the lowest detection rates in the South and Southeast regions, with low-risk clusters.

CONCLUSION

The leprosy detection rate showed an upward trend in Brazil between 2011 and 2019, with greater spatial concentration in the North, Northeast, and Midwest regions. Nevertheless, the study raises an alert for the programmatic sustainability of leprosy control in Brazil, considering the drop in the COVID-19 pandemic, presumably due to the influence of the reorganization of the development of initiatives and provision of services in face of COVID-19.

Spatial Heterogeneity and Its Influencing Factors of Syphilis in Ningxia, Northwest China, from 2004 to 2017: A Spatial Analysis

Syphilis remains a growing and resurging infectious disease in China. However, exploring the influence of environmental factors on the spatiotemporal distribution of syphilis remains under explore. This study aims to analyze the spatiotemporal distribution characteristics of syphilis in Ningxia, Northwest China, and its potential environmental influencing factors. Based on the standardized incidence ratio of syphilis for 22 administrative areas in Ningxia from 2004 to 2017, spatiotemporal autocorrelation and scan analyses were employed to analyze the spatial and temporal distribution characteristics of syphilis incidence, while a fixed-effect spatial panel regression model identified the potential factors affecting syphilis incidence. Syphilis incidence increased from 3.78/100,000 in 2004 to 54.69/100,000 in 2017 with significant spatial clustering in 2007 and 2009-2013. The "high-high" and "low-low" clusters were mainly distributed in northern and southern Ningxia, respectively. The spatial error panel model demonstrated that the syphilis incidence may be positively correlated with the per capita GDP and tertiary industry GDP and negatively correlated with the number of health facilities and healthcare personnel. Sex ratio and meteorological factors were not significantly associated with syphilis incidence. These results show that the syphilis incidence in Ningxia is still increasing and has significant spatial distribution differences and clustering. Socio-economic and health-resource factors could affect the incidence; therefore, strengthening syphilis surveillance of migrants in the economically developed region and allocating health resources to economically underdeveloped areas may effectively help prevent and control syphilis outbreaks in high-risk cluster areas of Ningxia.

Impact of the COVID-19 pandemic on the diagnosis of leprosy in Brazil: An ecological and population-based study

Background

The pandemic caused by COVID-19 has seriously affected global health, resulting in the suspension of many regular health services, making the diagnosis of other infections difficult. Therefore, this study aimed to assess the impact of the COVID-19 pandemic on the diagnosis of leprosy in Brazil during the year 2020.

Methods

We evaluated the monthly incidence of leprosy and calculated the percentage change to verify whether there was an increase or decrease in the number of leprosy cases in 2020, considering the monthly average of cases over the previous 5 years. We used interrupted time series analysis to assess the trend in the diagnosis of leprosy before and after the start of COVID-19 in Brazil and prepared spatial distribution maps, considering the percentage variation in each state.

Findings

We verified a reduction of 41.4% of leprosy cases in Brazil in 2020. Likewise, there was a reduction of leprosy notifications in children under 15 years-old (-56.82%). Conversely, the diagnosis of multibacillary leprosy increased (8.1%). There was a decreasing trend in the leprosy incidence in the general population between 2015 and 2020 in Brazil. Spatial distribution maps depicted a reduction of up to 100% in new cases of leprosy in some states.

Interpretation

Along with COVID-19 spread there was a reduction in leprosy diagnosis in the general population and children under 15 years-old, and also an increase in multibacillary cases diagnosed, signalling a serious impact of the pandemic on leprosy control strategies in Brazil.

Funding

This research received no specific grants.

Magnitude of visceral leishmaniasis and HIV coinfection and association with social determinants of health in the Northeast region of Brazil: a retrospective, spatiotemporal model (2010-2018)

The Northeast region of Brazil (NRB) includes the states with the highest prevalence of visceral leishmaniasis (VL), as well as those with significant increases in HIV cases. This study aims to analyze the spatiotemporal patterns of VL-HIV coinfection and its association with the social determinants of health (SDH) in the NRB. Time trend analysis and Bayesian spatial statistical inferences, Moran's autocorrelation, and retrospective space-time scanning were performed. Spatial regression modelling was used to build an explanatory model for the occurrence of VL-HIV coinfection within NRB. A total of 1550 cases of VL-HIV coinfection were confirmed. We observed a higher prevalence among males (1232; 83%), individuals aged from 20 to 59 years (850; 54.8%), non-white skin color (1,422; 91.7%), and with low education (550; 35.48%). NRB showed an increasing and significant trend in the detection rate of coinfection (APC, 5.3; 95% CI, 1.4 to 9.4). The states of Maranhão and Piauí comprised the high-risk cluster. The SDH that most correlated with the occurrence of coinfection were poor housing, low income, and low education. VL-HIV is dispersed in the NRB but chiefly affects states with greater social vulnerability. Taken together, these findings reinforce the necessity to implement surveillance strategies that will contribute to the reduction of cases in these populations.

Tendência temporal, distribuição e autocorrelação espacial da hanseníase no Brasil: estudo ecológico, 2011 a 2021

RESUMO Objetivo: Caracterizar a tendência temporal e o comportamento espacial da hanseníase no Brasil, de 2011 a 2021. Métodos: Estudo ecológico, com dados do Sistema de Informação de Agravos de Notificação, obtidos em junho de 2022. Calculou-se a taxa de detecção anual de casos novos de hanseníase por 100 mil habitantes. Para estimar a tendência das séries 2011–2019 e 2011–2021, empregou-se o modelo de regressão polinomial, testando polinômios de primeira, segunda e terceira ordem. Para a espacialidade, utilizaram-se as quebras naturais e, posteriormente, as estatísticas univariadas de Moran global e local. Adotou-se o nível de significância de 5% e as análises foram realizadas no Statistical Package for the Social Sciences — SPSS®, GeoDa® e QGIS®. Resultados: Os achados apontaram para a tendência crescente da incidência de hanseníase no Brasil, nas regiões e em 20 unidades da federação entre 2011 e 2019; contudo, houve decréscimo em grande parte do país ao se considerarem os anos pandêmicos. A espacialidade revelou que as maiores taxas de detecção, em todo o período, foram observadas nas Regiões Norte, Centro-Oeste e Nordeste, com clusters de alto risco, e as menores nas Regiões Sul e Sudeste, com aglomerados de baixo risco. Conclusão: A taxa de detecção da hanseníase apresentou tendência crescente no Brasil entre 2011 e 2019, com maior concentração espacial nas Regiões Norte, Nordeste e Centro-Oeste. Entretanto, o estudo traz um alerta para a sustentabilidade programática do controle da hanseníase no Brasil, dada a queda evidenciada na pandemia, presumivelmente por influência da reorganização da oferta de ações e serviços anteposta àCOVID-19.

Analysis of the myeloid-derived suppressor cells and annexin A1 in multibacillary leprosy and reactional episodes

Background

Leprosy is a chronic infectious disease caused by Mycobacterium leprae. Patients have distinct clinical forms, and the host´s immunological response regulate those manifestations. In this work, the presence of the myeloid-derived suppressor cell and the regulatory protein annexin A1 is described in patients with multibacillary leprosy and with type 1 and 2 reactions.

Methods

Patients were submitted to skin biopsy for histopathological analysis to obtain a bacilloscopic index. Immunofluorescence was used to detect myeloid-derived suppressor cells and annexin A1.

Results

The data demonstrated that the presence of granulocytic and monocytic myeloid-derived suppressor cells in leprosy patients. A high number of monocytic myeloid-derived suppressor cells were observed in lepromatous leprosy and type 2 reactional patients. The presence of annexin A1 was observed in all myeloid-derived suppressor cells. In particular, the monocytic myeloid-derived suppressor cell in the lepromatous patients has higher levels of this protein when compared to the reactional patients. This data suggest that the higher expression of this protein may be related to regulatory response against a severe infection, contributing to anergic response. In type 1 reactional patients, the expression of annexin A1 was reduced.

Conclusions

Myeloid-derived suppressor cell are present in leprosy patients and annexin A1 might be regulated the host response against Mycobacterium leprae.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06744-x.

Spatial clusters, social determinants of health and risk of maternal mortality by COVID-19 in Brazil: a national population-based ecological study

BACKGROUND

Detailed information on how socio-economic characteristics are related to COVID-19 incident cases and maternal deaths is needed. We investigated the spatial distribution of COVID-19 cases and maternal deaths in Brazil and their association with social determinants of health.

METHODS

This was a population-based ecological study with a spatial analysis of all cases and deaths of COVID-19 in the obstetric population. Data on COVID-19 cases and deaths in the obstetric population, social vulnerability, health inequities, and health system capacity at the municipal level were obtained from several publicly sources in Brazil. A Bayesian empirical local model was used to identify fluctuations of the indicators. Spatial statistic tests were used to identity the spatial clusters and measure the municipalities' risk of COVID-19 in the obstetric population. Beta regression was used to characterise the association between socio-economic indicators and the burden of COVID-19.

FINDINGS

A total of 13,858 cases and 1,396 deaths due to COVID-19 were recorded in Brazil from March 2020 to June 2021. There was a variation in the number of cases per municipality, with 105 municipalities with rates from 2,210 to 3,884 cases and 45 municipalities with rates from 3,884 to 7,418 cases per 100,000 live births. The maternal mortality ratio also varied widely across municipalities. There was a spatial dependence on smoothed maternal mortality rates (I Moran 0•10; P = 0•010), and 15 municipalities had higher risk of maternal deaths. Municipalities characterized by lower health resources and higher socioeconomic inequalities presented the highest rates of incidence and maternal mortality by COVID-19.

INTERPRETATION

In Brazil, COVID-19 cases and deaths in the obstetric population had a heterogeneous geographical distribution, with well-defined spatial clusters mostly located in the countryside. Municipalities with a high degree of socioeconomic dissimilarities showed higher maternal mortality rates than areas with better social and infrastructure indicators.

FUNDING

None.

High-risk transmission clusters of leprosy in an endemic area in the Northeastern Brazil: A retrospective spatiotemporal modelling (2001-2019)

OBJECTIVES

To analyse and map the leprosy risk areas in the state of Alagoas, an endemic region in the Northeastern Brazil, between 2001 and 2019.

METHODS

Ecological and time series study, using spatial analysis techniques. First, we analyse the epidemiological aspects of leprosy cases, using the data available in the Notifiable Diseases Information System; then, we used the segmented log-linear regression model to assess time trends. Spatial distribution was analysed by the Local Empirical Bayesian Estimator and by calculating the Global and Local Moran Index. Finally, spatiotemporal clusters were identified through scanning statistics, using the Kulldorf method of retrospective analysis.

RESULTS

We observed that Alagoas showed an average new case detection rate of 14.43/100,000 inhabitants between 2001 and 2019, being classified as highly endemic. The area of highest risk was the 9th health region (state hinterland), with increasing time trend (Annual Percentage Change/APC = 7.2; p-value < 0.05). Several clusters of high risk of leprosy transmission were verified in Alagoas, including the state capital and hinterland municipalities.

CONCLUSIONS

Our data indicate that active M. leprae transmission persists in Alagoas; that diagnosis is delayed and that there are high-risk areas, especially in inland municipalities.

Geospatial epidemiology of leprosy in northwest Bangladesh: a 20-year retrospective observational study

Background

Leprosy is known to be unevenly distributed between and within countries. High risk areas or ‘hotspots’ are potential targets for preventive interventions, but the underlying epidemiologic mechanisms that enable hotspots to emerge, are not yet fully understood. In this study, we identified and characterized leprosy hotspots in Bangladesh, a country with one of the highest leprosy endemicity levels globally.

Methods

We used data from four high-endemic districts in northwest Bangladesh including 20 623 registered cases between January 2000 and April 2019 (among ~ 7 million population). Incidences per union (smallest administrative unit) were calculated using geospatial population density estimates. A geospatial Poisson model was used to detect incidence hotspots over three (overlapping) 10-year timeframes: 2000–2009, 2005–2014 and 2010–2019. Ordinal regression models were used to assess whether patient characteristics were significantly different for cases outside hotspots, as compared to cases within weak (i.e., relative risk (RR) of one to two), medium (i.e., RR of two to three), and strong (i.e., RR higher than three) hotspots.

Results

New case detection rates dropped from 44/100 000 in 2000 to 10/100 000 in 2019. Statistically significant hotspots were identified during all timeframes and were often located at areas with high population densities. The RR for leprosy was up to 12 times higher for inhabitants of hotspots than for people living outside hotspots. Within strong hotspots (1930 cases among less than 1% of the population), significantly more child cases (i.e., below 15 years of age) were detected, indicating recent transmission. Cases in hotspots were not significantly more likely to be detected actively.

Conclusions

Leprosy showed a heterogeneous distribution with clear hotspots in northwest Bangladesh throughout a 20-year period of decreasing incidence. Findings confirm that leprosy hotspots represent areas of higher transmission activity and are not solely the result of active case finding strategies.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40249-021-00817-4.

Misdiagnosis of leprosy in Brazil in the period 2003 - 2017: spatial pattern and associated factors

BACKGROUND

Leprosy causes a range of symptoms, and most diagnoses are established based on the clinical picture. Therefore, false negative and positive diagnoses are relatively common. We analyzed the spatial pattern of leprosy misdiagnosis and associated factors in Brazil.

METHOD

Exploratory analyses of Kernel density of the new case detection rate (NCDR) and proportion of misdiagnosis in Brazil, 2003-2017. Factors associated with misdiagnosis were identified by logistic regression at the 5% significance level.

RESULT

A total of 574,181 new leprosy cases were recorded in Brazil within the study period, of which 7,477 (1.3%) were misdiagnoses. No spatial correlation was observed between the proportion of misdiagnoses and the NCDR. The likelihood of misdiagnosis was elevated for females [OR: 1.58 (1.51-1.66)], children [OR: 1.49 (1.36-1.64)]; paucibacillary [OR: 1.08 (1.02-1.13)], indeterminate clinical forms [OR: 2.37 (2.15-2.62)], for cases diagnosed in the frame of mass screenings [OR: 3.36 (3.09- 3.73)] and contact examination [OR: 2.30 (2.13-2.49)] and for cases with affected nerves but no skin lesions [OR: 2.47 (2.19-2.77)] when compared with those presenting both skin lesion and affected nerves.

CONCLUSION

Misdiagnosis of leprosy is not correlated with the endemicity level in Brazil but rather with personal, diagnosis-related and disease characteristics.

Incidence of and Factors Associated With Leprosy Among Household Contacts of Patients With Leprosy in Brazil

Importance

Despite progress toward reducing global incidence, leprosy control remains a challenge in low- and middle-income countries.

Objective

To estimate new case detection rates of leprosy among household contacts of patients with previously diagnosed leprosy and to investigate its associated risk factors.

Design, Setting, and Participants

This population-based cohort study included families registered in the 100 Million Brazilian Cohort linked with nationwide registries of leprosy; data were collected from January 1, 2007, through December 31, 2014. Household contacts of patients with a previous diagnosis of leprosy from each household unit were followed up from the time of detection of the primary case to the time of detection of a subsequent case or until December 31, 2014. Data analysis was performed from May to December 2018.

Exposures

Clinical characteristics of the primary case and sociodemographic factors of the household contact.

Main Outcomes and Measures

Incidence of leprosy, estimated as the new case detection rate of leprosy per 100 000 household contacts at risk (person-years at risk). The association between occurrence of a subsequent leprosy case and the exposure risk factors was assessed using multilevel mixed-effects logistic regressions allowing for state- and household-specific random effects.

Results

Among 42 725 household contacts (22 449 [52.5%] female; mean [SD] age, 22.4 [18.5] years) of 17 876 patients detected with leprosy, the new case detection rate of leprosy was 636.3 (95% CI, 594.4-681.1) per 100 000 person-years at risk overall and 521.9 (95% CI, 466.3-584.1) per 100 000 person-years at risk among children younger than 15 years. Household contacts of patients with multibacillary leprosy had higher odds of developing leprosy (adjusted odds ratio [OR], 1.48; 95% CI, 1.17-1.88), and the odds increased among contacts aged 50 years or older (adjusted OR, 3.11; 95% CI, 2.03-4.76). Leprosy detection was negatively associated with illiterate or preschool educational level (adjusted OR, 0.59; 95% CI, 0.38-0.92). For children, the odds were increased among boys (adjusted OR, 1.70; 95% CI, 1.20-2.42).

Conclusions and Relevance

The findings in this Brazilian population-based cohort study suggest that the household contacts of patients with leprosy may have increased risk of leprosy, especially in households with existing multibacillary cases and older contacts. Public health interventions, such as contact screening, that specifically target this population appear to be needed.

Predicting the detection of leprosy in a hyperendemic area of Brazil: Using time series analysis

BACKGROUND

Brazil has the second highest prevalence of leprosy worldwide. Autoregressive integrated moving average models are useful tools in surveillance systems because they provide reliable forecasts from epidemiological time series.

AIM

To evaluate the temporal patterns of leprosy detection from 2001 to 2015 and forecast for 2020 in a hyperendemic area in northeastern Brazil.

METHODS

A cross-sectional study was conducted using monthly leprosy detection from the Brazil information system for notifiable diseases. The Box-Jenkins method was applied to fit a seasonal autoregressive integrated moving average model. Forecasting models (95% prediction interval) were developed to predict leprosy detection for 2020.

RESULTS

A total of 44,578 cases were registered with a mean of 247.7 cases per month. The best-fitted model to make forecasts was the seasonal autoregressive integrated moving average ((1,1,1); (1,1,1)). It was predicted 0.32 cases/100,000 inhabitants to January of 2016 and 0.38 cases/100,000 inhabitants to December of 2020.

LIMITATIONS

This study used secondary data from Brazil information system for notifiable diseases; hence, leprosy data may be underreported.

CONCLUSION

The forecast for leprosy detection rate for December 2020 was < 1 case/100,000 inhabitants. Seasonal autoregressive integrated moving average model has been shown to be appropriate and could be used to forecast leprosy detection rates. Thus, this strategy can be used to facilitate prevention and elimination programmes.

Space-time risk cluster of visceral leishmaniasis in Brazilian endemic region with high social vulnerability: An ecological time series study

BACKGROUND

Despite visceral leishmaniasis (VL) being epidemic in most Brazilian regions, the Northeast region is responsible for the highest morbidity and mortality outcomes within the country.

OBJECTIVE

To analyse the spatiotemporal dynamics of VL cases to identify the temporal trends and high-risk areas for VL transmission, as well as the association of the disease with social vulnerability in Brazilian Northeast.

METHODS

We carried out an ecological time series study employing spatial analysis techniques using all VL confirmed cases of 1,794 municipalities of Brazilian Northeast between the years 2000 to 2017. The Social Vulnerability Index (SVI) was used to represent the social vulnerability. Incidence rates were standardized and smoothed by the Local Empirical Bayesian Method. Time trends were examined through segmented linear regression. Spatiotemporal analysis consisted of uni- and bivariate Global and Local Moran indexes and space-time scan statistics.

RESULTS

Incidence rate remained stable and ranged from 4.84 to 3.52 cases/100,000 inhabitants. There was higher case prevalence between males (62.71%), children and adolescents (63.27%), non-white (69.75%) and urban residents (62.58%). Increasing trends of new cases were observed among adult male subjects (≥ 40 years old) and urban residents. Importantly, VL incidence showed a direct spatial dependence. Spatial and space-time clusters were identified in sertão and meio-norte sub-regions, overlapping with high social vulnerability areas.

CONCLUSIONS

VL is a persistent health issue in Brazilian Northeast and associated with social vulnerability. Space-time clustering of VL cases in socially vulnerable municipalities demands intersectoral public policies of surveillance and control, with focus on reducing inequalities and improving living conditions for regional inhabitants.

Spatial and spatiotemporal dynamics of visceral leishmaniasis in an endemic North-eastern region of Brazil

Visceral Leishmaniasis (VL) is a neglected disease with increasing incidence in Brazil, particularly in the North-eastern. The aim of this study was to analyze the spatial and spatiotemporal dynamics of VL in an endemic region of North-eastern Brazil, between 2009 and 2017. Using spatial analysis techniques, an ecological and time series study was made regarding VL cases in Sergipe filed as notifiable disease events. With data from the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística, IBGE), a digital population and cartographic baseline was established. Segmented linear regression was used to examine the temporal trends. The statistical analysis methods of Global and Local Moran' I, local Bayesian empirical methodology and spatial-temporal scanning were used to produce thematic maps. High instances were found among adults, males, urban residents, non-Whites and persons with low levels of education. A decrease in the recovery rate and an increase in the proportion of urban cases and lethality was found. A heterogeneous VL distribution with spatiotemporal agglomeration on the seaside of the state was seen in Sergipe. To better manage the disease, new research is encouraged together with development of public health strategies. Further, improving health care networks, especially primary care, is suggested as this approach has a key role in health promotion, prevention and monitoring of the most prevalent diseases.

Borderline lepromatous leprosy with primary clinical manifestation in a patient with a long-term dermatological history

Despite the low number, the cases of leprosy continue to be detected, more often on endemic territories. In Russian Federation one of the endemic territories is located in Astrakhan region. The long incubation period eventually leads to inability to identify the source of infection. The combination of the leprosy with other dermatoses complicates the diagnosing. The isolated and early skin manifestations of leprosy can be mistaken for the clinical features of other dermatoses. This article presents the description of a case study of border line lepromatosis leprosy in a patient with a long-term dermatological background. A 66-year-old male was followed up for 14 years under different dermatological diseases. In 2017, after a change in the nature of rashes, atypical for supervised nosological forms, and in connection with the resistance of clinical manifestations of diseases to the therapy, a clinical diagnosis of leprosy was established. To verify this diagnosis, the patient was sent to the Federal State Budgetary Institution "Research Institute for the Study of Leprosy". At admission, he complained of rashes on the skin of the face, trunk, extremities, accompanied by itching, swelling, weakness and numbness in the distal extremities. As a result of clinical, laboratory examination (bacterioscopic examination of scarification from the skin, serological examination, pathomorphological examination of skin biopsies), the diagnosis of the underlying disease was made: leprosy, borderline lepromatous form, active stage. Complications of the underlying disease: chronic specific polyneuropathy with sensitive disorders. The described clinical situation illustrates the problem of early diagnosis of leprosy due to the variety of manifestations and low alertness of clinicians.

Borderline lepromatous leprosy with primary clinical manifestation in a patient with a long-term dermatological history

Despite the low number, the cases of leprosy continue to be detected, more often on endemic territories. In Russian Federation one of the endemic territories is located in Astrakhan region. The long incubation period eventually leads to inability to identify the source of infection. The combination of the leprosy with other dermatoses complicates the diagnosing. The isolated and early skin manifestations of leprosy can be mistaken for the clinical features of other dermatoses. This article presents the description of a case study of border line lepromatosis leprosy in a patient with a long-term dermatological background. A 66-year-old male was followed up for 14 years under different dermatological diseases. In 2017, after a change in the nature of rashes, atypical for supervised nosological forms, and in connection with the resistance of clinical manifestations of diseases to the therapy, a clinical diagnosis of leprosy was established. To verify this diagnosis, the patient was sent to the Federal State Budgetary Institution "Research Institute for the Study of Leprosy". At admission, he complained of rashes on the skin of the face, trunk, extremities, accompanied by itching, swelling, weakness and numbness in the distal extremities. As a result of clinical, laboratory examination (bacterioscopic examination of scarification from the skin, serological examination, pathomorphological examination of skin biopsies), the diagnosis of the underlying disease was made: leprosy, borderline lepromatous form, active stage. Complications of the underlying disease: chronic specific polyneuropathy with sensitive disorders. The described clinical situation illustrates the problem of early diagnosis of leprosy due to the variety of manifestations and low alertness of clinicians.

Spatiotemporal clustering, social vulnerability and risk of congenital syphilis in northeast Brazil: an ecological study

BACKGROUND

To investigate the spatial distribution of congenital syphilis (CS) and its association to social vulnerability indexes in northeast Brazil.

METHODS

This was an ecological study referring to all cases of CS and CS deaths recorded in the northeast region of Brazil from 2008 to 2015. Data were obtained from three Brazilian information systems. We examined statistical correlations between CS indicators by state and municipality and their socioeconomic and social vulnerability characteristics. We used Bayesian empirical local models to identify fluctuations of the indicators. Spatial statistical tests were used to identify spatial clusters and the municipalities at high risk of CS.

RESULTS

The incidence of CS ranged from 2.1 cases/1000 live births (LB) in 2008 to 6.9/1000 LB in 2015, with an annual increase of 19.9% (p < 0.001). The mortality coefficient of CS ranged from 2.9/1000 LB in 2008 to 6.5/1000 LB in 2015, resulting in an annual increase of 15.1% (p < 0.001). Nine spatial clusters were identified. Cases of congenital syphilis occurred in well-defined spatiotemporal clusters and in areas with high levels of social vulnerability.

CONCLUSIONS

CS incidence is associated with social vulnerability. CS control programmes should target spatial clusters and populations with high levels of social vulnerability.